ABSTRACT
Background and Objectives:
Diabetic nephropathy (DN) is a serious complication of diabetes that requires close monitoring and proper management in order to prevent it. Family physicians play a crucial role in guiding and helping patients to control their blood sugar levels, hence preventing DN. Our objectives are to evaluate the knowledge, attitudes, and practices of family physicians regarding diabetic nephropathy in general and to study the relationship between the attitudes, and practices particularly.
Materials and Methods:
This is an analytical cross-sectional study that utilized an online prestructured questionnaire. All family residents, specialists, fellows, and consultants working in Riyadh city, KSA Capital, during the year 2024 were eligible for inclusion in our study. The structured questionnaire was adopted form the literature and tested for reliability.
Results:
A total of 235 responses were collected from family physicians. Senior residents represented the majority with 59.1%, while consultants accounted for only 15.3%. Over 90% of the participants exhibited high levels of positive attitudes and practices toward educating diabetic patients to manage their condition by themselves, to avoid risk factors of developing any other complications, and to change their lifestyle. We also recorded a positive relationship between family physicians’ attitude and their practice. The highest positive significant relationship was 53%. It is recorded between family physicians’ attitude and their practice regarding education of the diabetic patients about the importance of patients’ self-management. Improving the attitude of family physicians toward the management of diabetics to avoid or delay the emergence of DN will approximately increase their practices by 46%.
Conclusion:
Our study revealed a strong direct relationship between family physicians’ attitudes and their practices in managing DN. Our findings underscore the importance of enhancing family physicians’ attitudes through targeted training and awareness programs to improve DN management and reduce the burden of diabetes-related complications.
Keywords: Diabetic nephropathy, DM, family physicians, nephropathy, renal disease, primary healthcare
Introduction
The prevalence of Type 2 Diabetes in Saudi Arabia was recorded to be high over the previous 20 years. The World Health Organization has identified Saudi Arabia as having the second-highest prevalence of diabetes in the Middle East.[1] It was estimated that nearly 47% of Saudi Arabia’s population aged 25 and above will be affected by diabetes by 2022.[2] However, on 2022, Almubark and colleagues reported that the actual prevalence of diabetes in KSA was about 12%.[3]
Diabetes is the leading cause of end-stage renal disease (ESRD) in Saudi Arabia, with nearly one-third of type 2 diabetic patients developing renal kidney disease (RKD) as a complication.[4] The high prevalence of diabetes, coupled with rising rates of obesity and sedentary lifestyles, exacerbates the risk of diabetic nephropathy (DN), making it a critical public health issue. Almost one-third of type 2 Saudi diabetic population had associated with RKD as a complication of diabetes. That increased incidence of diabetic nephropathy or RKD represents a major impact on the healthcare system and economy in Saudi Arabia.[5]
Family physicians should provide a close monitoring and collaboration with the diabetic patients in order to prevent long-term complications such as chronic kidney diseases, “CKDs”, and nephropathy. In order to reduce the national burden of the DM, family physicians should lead a comprehensive continued health campaign as well as an educational program to influence the progress of DM to more serious chronic complications.[6]
Recent research has recommended increasing efforts to enhance healthcare services for diabetic patients with renal disease. Additionally, these studies advocated for the deep involvement of family physicians in the early detection of renal disease in diabetic patients.[7]
The management of DN by family physicians is shaped by several factors, with training in primary healthcare settings playing a significant role. Alfaifi and colleagues recently highlighted that physicians with adequate training are more likely to follow clinical guidelines for DN management effectively.[8] Additionally, patient education is crucial for improving outcomes and achieving better control of the disease.[9]
In Saudi Arabia, the Saudi Clinical Practice Guidelines for the management of diabetes are continuously updated. Family physicians are recognized as the first line of practitioners managing diabetes cases, including DN. Assessing the knowledge, attitudes, and practices, “KAP”, regarding DN among family physicians is crucial for coordinated efforts to prevent DN progression from early to complicated stages. In the KSA, several studies have examined the factors influencing KAP scores among family physicians related to DN. This study was designed with the goal of evaluating local data from various primary health centers in Riyadh, KSA, to support the planning and implementation of DN-related healthcare services.
The objective of this study was to measure knowledge, attitudes, and practices (KAP) of family physicians regarding DN in general and to study the relationship between the attitudes and practices particularly.
Materials and Methods
This is an observational analytical cross-sectional study that employs a self-administered questionnaire adapted from a validated tool to assess knowledge, attitude, and practice of family physicians toward DN in Riyadh, Saudi Arabia, on 2024. The questionnaire will be distributed through social media platforms using Google Forms. It included questions which focused on screening for the family physicians’ knowledge about DN and explores their attitude toward its early detection and dealing with the recently affected or chronic cases as well as exploring the practices they used to follow and to manage the patients. The study was conducted from June 2024 to December 2024, targeting to include all family physicians working in Riyadh, KSA, with a calculated sample size of 235. The survey utilized a quantitative approach to collect the primary data questionnaire. Data collection will be conducted through Google Forms and distributed across social media platforms. Section A captures participants’ demographics (gender, nationality, position, and level of experience), while Section B evaluates specifically the physicians’ opinions about research questions. The authors collected and stored the questionnaire data in an Excel sheet for streamlined analysis.
The study population considers all family physicians in Riyadh, Saudi Arabia, in 2024, with a total of about 600 physicians (567 as per the Statistical Yearbook, Ministry of Health, KSA 2022 (https://www.moh.gov.sa/en)).[10] According to statista.com, assuming a response distribution of 50%, a 95% confidence level, and a 5% margin of error, the calculated sample size is 235, as determined using the Raosoft website (http://www.raosoft.com).[11] The inclusion criterion was all family physicians working in Riyadh, Saudi Arabia, during the year 2024: residents, specialists, fellows, and consultants. Exclusion criteria included physicians from other specialties, interns, general physicians, and rotators having less than 6 months’ rotations inside Riyadh.
The questionnaire was adapted from a validated tool used previously by Faisal Ibrahim Bin Hawaidi and colleagues (2023) and revised to suit our context.[12] A pilot study involving 30 physicians outside the sample population was conducted to test the questionnaire’s reliability. Questionnaire reliability will be established through the test–retest method, which is used to test changes when measuring a stable individual characteristic on different occasions.[13] The pilot results showed a Cronbach’s alpha of 0.81 and 0.72 consecutively, indicating good internal consistency (>0.6). The questionnaire consists of two main sections; the first section considered the demographic data, while the second section included the information related to DN knowledge, attitude, and practices of family physicians toward DN patients. Data were collected, categorized, and coded using Statistical Package for Social Sciences Under Windows – SPSSWIN-V23. The mean, standard deviation, frequencies, and percentages were calculated for each question, while Pearson correlation coefficient measures the strength and direction of the correlation between attitude and practice variables. Paired t-test (t) was used to study the statistical significance of the differences between the averages of two arithmetic groups. The statistical significance for any applied statistical test is set to 0.05 (P < 0.05). Likert scores of 1–1.66 were considered low, 1.67 to less than 2.33 were considered moderate, and 2.33–3 were considered high.
Results
Table 1 shows the distribution of demographic characteristics and experience of the participated family physicians among the questionnaire sample. Our current research included a total of 235 responses from family doctors working in Riyadh, Saudi Arabia, in 2024, with slightly more females (54.0%) participating than males (46.0%). The majority was Saudis (95.3%). Most of the participants (79.5%) were from young physicians, that is, up to 5 years’ experience. Residents represented the majority with 59.1%, while only 15.3% of consultants shared in our research.
Table 1.
Demographic characteristics and experience of the participated family physicians
| Demographic variant | Number (percentage %) | |
|---|---|---|
| Gender | Male | 108 (46%) |
| Female | 127 (54%) | |
| Nationality | Saudi | 224 (95.3%) |
| Non-Saudi | 11 (4.7%) | |
| Experience | Less than 1 year | 33 (14%) |
| 1-2 years | 72 (30.6%) | |
| 3-5 years | 82 (34.9%) | |
| 6-10 years | 15 (6.4%) | |
| More than 10 years | 33 (14%) | |
| Current position | Registrar | 55 (23.4%) |
| Resident | 139 (59.1%) | |
| Fellow | 5 (2.1%) | |
| Consultant | 36 (15.3%) | |
| How many diabetic patients (approximately) do you see each week? | Less than 10 patients | 51 (21.7%) |
| 10-20 patients | 107 (45.5%) | |
| 21-30 patients. | 42 (17.9%) | |
| More than 30 patients | 35 (14.9%) | |
| Do you have an interest to enter diabetology fellowship? | Yes | 54 (23%) |
| May be | 86 (36.6%) | |
| No | 95 (40.4%) | |
Table 2 demonstrates the participants’ responses to their knowledge about the frequency of monitoring diabetic patients for nephropathy according to their type of diabetes.
Table 2.
Participants’ responses to the items of knowledge section
| Number (percentage) | Mean | SD | Interpretation | |
|---|---|---|---|---|
| Agree | 78 (33.2%) | 2.08 | 0.76 | Neutral |
| Neutral | 97 (41.3%) | |||
| Disagree | 60 (25.5%) | |||
| Total | 235 |
Figure 1 dmonstrats the demographic characteristics and experience of the participated family physicians.
Figure 1.
Demographic characteristics and experience of the participated family physicians
In general, participants were neutrally accepting that monitoring of type 1 DM should be more intensive than that for type 2 DM.
Tables 3 and 4 demonstrate consecutively the participants’ responses to their attitude and practices towardsmanagement of diabetics in order to prevent or early detect the DN.
Table 3.
Participants’ responses to the items of attitude section
| Attitudes of family physicians toward diabetic nephropathy arranged according to the largest arithmetic mean and the lowest standard deviation | Agree (%) | Neutral (%) | Disagree (%) | Mean | Std deviation | Interpretation | |
|---|---|---|---|---|---|---|---|
| I would educate my diabetic nephropathy patients about the importance of changing his/her lifestyle | n (%) | 219 (93.2%) | 16 (6.8%) | 0 | 2.93 | 0.25 | Agree |
| I would review the management of diabetes in patient diagnosed with diabetic nephropathy | n (%) | 217 (92.3%) | 18 (7.7%) | 0 | 2.92 | 0.27 | Agree |
| I would screen all diabetics for diabetic nephropathy | n (%) | 216 (91.9%) | 16 (6.8%) | 3 (1.3%) | 2.91 | 0.33 | Agree |
| I would educate my diabetic nephropathy patients about the importance of self-management | n (%) | 215 (91.5%) | 17 (7.2%) | 3 (1.3%) | 2.90 | 0.34 | Agree |
| I would educate my diabetic patients about diabetic nephropathy as a complication of their condition even if he/she is controlled | n (%) | 180 (76.6%) | 48 (20.4%) | 7 (3.0%) | 2.74 | 0.50 | Agree |
| General | 2.88 | 0.212 | Agree | ||||
Table 4.
Participants’ responses to the items of practice section
| Practices of Family Physicians Toward Diabetic Nephropathy | Agree | Neutral | Disagree | Mean | Std deviation | Interpretation | |
|---|---|---|---|---|---|---|---|
| Actually, I always educate my diabetic nephropathy patients about importance of changing his/her lifestyle | n (%) | 209 (88.9%) | 20 (8.5%) | 6 (2.6%) | 2.86 | 0.41 | Agree |
| I review the whole management of diabetes in patient diagnosed with diabetic nephropathy | n (%) | 198 (84.3%) | 35 (14.9%) | 2 (0.9%) | 2.83 | 0.40 | Agree |
| Actually, I educate every diabetic nephropathy patient about the importance of self-management | n (%) | 193 (82.1%) | 38 (16.2%) | 4 (1.7%) | 2.80 | 0.44 | Agree |
| Actually, I screen every diabetic patient for the presence of diabetic neuropathy | n (%) | 192 (81.7%) | 38 (16.2%) | 5 (2.1%) | 2.80 | 0.45 | Agree |
| I always screen every diabetic patient for proteinuria in order to detect any renal kidney disease at early stage | n (%) | 183 (77.9%) | 47 (20.0%) | 5 (2.1%) | 2.76 | 0.48 | Agree |
| Actually, I always educate all of my DM patients about diabetic nephropathy as a complication of their condition | n (%) | 78 (33.2%) | 97 (41.3%) | 60 (25.5%) | 2.70 | 0.55 | Agree |
| I always counsel every diabetic patient about the risk factors of diabetic nephropathy | n (%) | 163 (69.4%) | 63 (26.8%) | 9 (3.8%) | 2.66 | 0.55 | Agree |
| I always screen every diabetic nephropathy patient every examination time for other complications | n (%) | 156 (66.4%) | 68 (28.9%) | 11 (4.7%) | 2.62 | 0.58 | Agree |
| General | 2.75 | 0.482 | Agree | ||||
Figure 2 demonstrats the practices of family physicians toward diabetic nephropathy arranged ascendingly.
Figure 2.
The practices of family physicians toward diabetic nephropathy arranged ascendingly
Table 5 shows the correlation between attitudes and practices of family physicians toward DN while dealing with diabetics. It is clear from Table 5 that there is an average direct relationship between attitude and practice regarding education of the diabetic patients about DN as a complication of their condition even if they are controlled, where the value of the correlation coefficient t = 0.361 with a level of significance (0.00). The increase in the attitude is accompanied by a 36% increase in the practice. The highest impact of improving practice by 53% is observed in case of increasing attitude to educate the DN patients about the importance of self-management.
Table 5.
The correlation between attitudes and practices of family physicians towards DN while dealing with Diabetics
| The practices of family physicians towards DN while dealing with Diabetics The Attitude of family physicians towards DN while dealing with Diabetics | Actually, I always educate all of my DM patients about diabetic nephropathy as a complication of their condition. |
| I would educate my diabetic patients about diabetic nephropathy as a complication of their condition even if he/she is controlled. | Pearson Correlation 0.361** |
| Sig. (2-tailed) 0.000 | |
| N 235 | |
|
| |
| The practices of family physicians towards DN while dealing with Diabetics The Attitude of family physicians towards DN while dealing with Diabetics | Actually, I always educate my diabetic nephropathy patients about importance of changing his/her Lifestyle. |
|
| |
| I would educate my diabetic nephropathy patients about the importance of changing his/her Lifestyle. | Pearson Correlation 0.281** |
| Sig. (2-tailed) 0.000 | |
| N 235 | |
|
| |
| The practices of family physicians towards DN while dealing with Diabetics The Attitude of family physicians towards DN while dealing with Diabetics | Actually, I educate every diabetic nephropathy patient about the importance of self-management |
|
| |
| I would educate my diabetic nephropathy patients about the importance of self-management | Pearson Correlation 0.533** |
| Sig. (2-tailed) 0.000 | |
| N 235 | |
|
| |
| The practices of family physicians towards DN while dealing with Diabetics The Attitude of family physicians towards DN while dealing with Diabetics | I review the whole management of diabetes in patient diagnosed with diabetic nephropathy. |
|
| |
| I would review the management of diabetes in patient diagnosed with diabetic nephropathy | Pearson Correlation 0.366** |
| Sig. (2-tailed) 0.000 | |
| N 235 | |
|
| |
| The practices of family physicians towards DN while dealing with Diabetics The Attitude of family physicians towards DN while dealing with Diabetics | Actually, I screen every diabetic patient for the presence of diabetic neuropathy |
|
| |
| I would screen all diabetics for diabetic nephropathy | Pearson Correlation 0.382** |
| Sig. (2-tailed) 0.000 | |
| N 235 | |
**Correlation is significant at the 0.01 level (2-tailed).
In general, there is a strong direct relationship between the family physicians’ attitude and their practices concerning the management of DN, as indicated by Table 6, with a correlation coefficient of 0.458 with a significance level of 0.00. Improving the attitude of family physicians toward the management of diabetics to avoid or delay the emergence of DN will approximately increase their practices by 46%.
Table 6.
Overall relationship between the attitude of family physicians and their practices concerning the DN management
| Statistical Analysis | Practices | |
|---|---|---|
| Attitude | Pearson Correlation | 0.458** |
| Sig. (2-tailed) | 0.000 | |
| n | 235 |
**Correlation is significant at the 0.01 level (2-tailed)
Table 6 demonstrates the overall relationship between the attitude of family physicians and their practices concerning the DN management.
Also, Table 7 demonstrates the attitude and practices of family physicians toward DN according to their clinical rank.
Table 7.
Attitude and practices of family physicians toward diabetic nephropathy according to their clinical rank
| The clinical rank | Mean±SD | f | Sig | |
|---|---|---|---|---|
| Attitude | Registrar | 2.91±0.13 | 1.257 | 0.29 |
| Resident | 2.87±0.24 | |||
| Consultant | 2.91±0.22 | |||
| Fellow | 2.76±0.22 | |||
| Practices | Registrar | 2.78±0.20 | 4.019 | 0.008** |
| Resident | 2.71±0.33 | |||
| Consultant | 2.89±0.18 | |||
| Fellow | 2.80±0.45 |
It is clear from the above table that there are significant differences between the averages of family physicians’ practices according to their clinical rank; that is, the t value was (4.019) with a level of significance (0.008), which is less than (0.05). Accordingly, there are differences between the averages of family physicians in favor of the consultant with the highest average, while there are no statistically significant differences between different ranks of the family physicians regarding their attitude.
Discussion
The global prevalence of diabetes is rising dramatically, establishing an international health issue and placing a considerable burden on national healthcare systems.[3] As a result, the prevalence of DN as a common and debilitating complication of diabetes is anticipated to increase.[14]
Numerous studies have extensively explored the relationship between diabetes and renal impairment plus the importance of early detection in preventing and managing complications as the practices that can enhance patients’ quality of life.[15] From that perspective, family physicians can contribute significantly to the primary care of diabetics as they are ideally positioned to provide holistic, comprehensive, patient-centered care that includes all aspects of the patients, that is, psychological, physical, nutritional, and social. The interference can occur through effectively managing any potential complications such as DN and thereby achieve better patients’ quality of life.[16]
According to recent international guidelines of Kidney Disease Improving Global Outcomes (KDIGO), healthcare workers managing diabetes should focus on educating their diabetic patients for different important issues as the risk of kidney diseases secondary to uncontrolled diabetes, the importance of patient’s self-management, and the value of changing of life style including daily exercise, stop smoking, and changing improper diet habits.[17] Additionally, at the national level, the Saudi diabetes clinical practice guidelines issued in 2021 by the Saudi National Diabetes Center recommended encouraging all diabetics to be educated to follow the ideal behaviors in order to self-manage diabetes.[18] In our study, we reported a significant relationship between family physicians’ attitude and their practices regarding DN patients’ education for the importance of changing their lifestyle as well as importance of self-management. That attitude and those practices are consistent with the Saudi national recommendation to encourage all diabetics to enroll in the “Diabetes Self-Management Education and Support (DSMES)” program.[18]
The majority of our participants demonstrated an excellent level of attitude and practice with a median score of (2.88/3 ± 0.212) and (2.75/3 ± 0.482), respectively. Nevertheless, we recommend increasing awareness sessions and training to maximize the impact of family physicians’ attitude toward correct management of DN and demonstrate the influence of sticking to proper attitude over applying the right practices regarding DN. Also, it is essential to provide family physicians with all relevant clinical guidelines and to enhance access to these guidelines in any clinical setting.
Our study also provides positive insights about Riyadh family physicians’ practices regarding counseling every diabetic patient about the risk factors of DN as well as proper patient examination for other complications every clinical visit. According to the updated international guidelines, regular reassessment of risk factors of diabetes’ morbidity should be conducted every 3 to 6 months.[17] According to our family medicine participants, the primary investigation conducted to diagnose DN was reported to be proteinuria, which is again consistent with the recommended guidelines.
In consistence with our findings, on 2022, at Zhongshan Hospital-Fudan University/Shanghai-China, the performance of Primary Healthcare Physicians was positively evaluated. The study assumed positive evaluation of Primary Healthcare Physicians regarding their management of diabetic micro-angiopathy including DN.[19]
Contrary to our study, research on the management of PHP “Primary Healthcare Physicians” of DKD conducted in Shanghai, China, in 2023 demonstrated inadequate practices among PHP in both screening and managing DN among other vascular complications.[20] Almost the same result had been recorded 5 years earlier in the same city. Moreover, that study suggested the improvement of the training courses offered to both the physicians and the patients.[21] In Cotonou – Benin, on 2016, another study revealed both poor attitude and poor practices of family physicians regarding early detection of DN in diabetics. That study also suggested a high impact on continuous medical learning and training in order to improve those attitudes and practices.[22] The same results were recorded at the beginning of this century in rural and urban areas of Pakistan where the researchers had emphasized on the importance of awareness programs for family physicians to improve their attitude and practices.[23] A previous Chinese study revealed that doctors and nurses exhibited positive attitudes toward DN management; however, their knowledge and practices were found to be insufficient. The study emphasized a significant gap in achieving optimal DN care. It recommended additional training to enhance family physicians’ engagement and improve patient care.[24]
In 2024, family physicians in Riyadh, KSA, demonstrated exemplary attitudes and practices in managing diabetic patients to mitigate the risk of DN. Over 90% of the participants exhibited high levels of positive attitudes and practices toward educating diabetic patients to change their lifestyle and to manage their condition by themselves in order to avoid risk factors of developing any other complications. However, there is room for improvement in translating positive attitudes into consistent practices. We recommend nationwide training programs, the integration of DN guidelines into primary care protocols, and the use of technology (e.g., telemedicine) to enhance DN management. Future research should explore barriers for implementation and assess the long-term impact of interventions on patient outcomes.
Limitations of this study
Although our study was conducted in the capital of Saudi Arabia, the generalization of the findings cannot be accepted. To determine if our findings are more broadly applicable, a large-scale study to assess the quality of family physicians would be needed. Also, the study of knowledge item was limited in order to facilitate the data-gathering process. Nevertheless, our study provides insights into the consistency between the attitudes and practices of family physicians in Saudi Arabia and demonstrates the relationship between their attitudes and practices. Our research is the first in the field of comparing the attitudes and practices of family physicians toward the management of DN.
Future aspects of the study
Future research should explore the knowledge, attitudes, and practices of family physicians all over Saudi Arabia in managing diabetic patients to mitigate the risk of DN. Also, future research should explore value of implementation of primary care DN protocols and assess the long-term impact of interventions on patient outcomes.
Author contributions
RSAls: Manuscript editing. RSAlm: Experimental studies, data acquisition, data analysis. YFA: Integrity of the work as a whole from inception to published article. AAMA: Concept, design, literature search and manuscript review.
Patients’ consent form
Informed consent was secured from all participants, ensuring anonymity and confidentiality.
Ethical approval and/or institutional review board (IRB) approval
Ethical approval was obtained from King Saud Medical City (KSMC)- Riyadh/KSA., and The questionnaire was validated after receiving the approval of King Saud Medical City (KSMC) # H0RE-10-June24-04.
Data availability statement
We encourage all authors of articles published in MDPI journals to share their research data. In this section, please provide details regarding where data supporting reported results can be found, including links to publicly archived datasets analyzed or generated during the study. Where no new data were created, or where data is unavailable due to privacy or ethical restrictions, a statement is still required. Suggested Data Availability Statements are available in section “MDPI Research Data Policies” at https://www.mdpi.com/ethics.
Conflict of interest
None to be declared.
Abbreviations
The following abbreviations are used in this manuscript:
DN: Diabetic Nephropathy, RKD: Renal Kidney Disease, CKDs: chronic kidney diseases, FP: family physicians, DM: Diabetes, Mellitus; KSMC: King Saud Medical City; KDIGO: Kidney Disease Improving Global Outcomes.
Acknowledgment
Authors acknowledge King Saud Medical City (KSMC) for the administrative and technical support.
Funding Statement
None.
References
- 1.Jarrar M, Abusalah MAH, Albaker W, Al-Bsheish M, Alsyouf A, Al-Mugheed K, et al. Prevalence of type 2 diabetes mellitus in the general population of Saudi Arabia, 2000-2020: A systematic review and meta-analysis of observational studies. Saudi J Med Med Sci. 2023;11:1–10. doi: 10.4103/sjmms.sjmms_394_22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Al-Quwaidhi AJ, Pearce MS, Sobngwi E, Critchley JA, O’Flaherty M. Comparison of type 2 diabetes prevalence estimates in Saudi Arabia from a validated Markov model against the international diabetes federation and other modelling studies. Diabetes Res Clin Pract. 2014;103:496–503. doi: 10.1016/j.diabres.2013.12.036. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Almubark RA, Althumairi NA, Alhamdan AA, AlNujaidi HY, Alzayer R, Almubark SA, et al. Socioeconomic and behavioral disparities among diabetics in Saudi Arabia: A nation-wide descriptive study. Diabetes Metab Syndr Obes. 2022;15:2693–703. doi: 10.2147/DMSO.S352769. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Naeem Z. Burden of diabetes mellitus in Saudi Arabia. Int J Health Sci (Qassim) 2015;9:V–VI. doi: 10.12816/0024690. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Akbar DH, Mira SA, Zawawi TH, Malibary HM. Subclinical diabetic neuropathy: A common complication in Saudi diabetics. Saudi Med J. 2000;21:433–7. [PubMed] [Google Scholar]
- 6.Al-Hazzaa HM, Abahussain NA, Al-Sobayel HI, Qahwaji DM, Musaiger AO. Physical activity, sedentary behaviors and dietary habits among Saudi adolescents relative to age, gender and region. Int J Behav Nutr Phys Act. 2011;8:140. doi: 10.1186/1479-5868-8-140. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Amelia R, Sari DK, Muzasti RA, Fujiati II, Wijaya H. Early detection of diabetic nephropathy based on albumin creatinine ratio (acr) in type 2 diabetes mellitus patients in Medan. Indonesia. Fam Med Prim Care Rev. 2021;23:135–8. [Google Scholar]
- 8.Alfaifi AJ, Abdaly AY, Ghazwani BM, Gosadi IM. Physicians’ practices in diabetic nephropathy in primary healthcare centers in Jazan city, Saudi Arabia, 2023. Medicina (Kaunas) 2024;60:372. doi: 10.3390/medicina60030372. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Snyder MJ, Gibbs LM, Lindsay TJ. Treating painful diabetic peripheral neuropathy: An update. Am Fam Physician. 2016;94:227–34. [PubMed] [Google Scholar]
- 10. https://www.moh.gov.sa/en/Ministry/Statistics/book/Documents/CBAHI-Accredited-Private-Hospitals-2022.xlsx.
- 11. http://www.raosoft.com/samplesize.html.
- 12.Bin hawaidi FI, Alhatlani AA, Aldosery AA, Almutairi HS, Aljuraifani IM. Knowledge, attitude, and practice of family physicians toward diabetic neuropathy in Riyadh, Saudi Arabia. Int J Adv Res. 2023;11:1333–40. [Google Scholar]
- 13.Vilagut G. Encyclopedia of Quality of Life and Well-Being Research. Dordrecht: Springer; 2014. Test-retest reliability; pp. 6622–5. [Google Scholar]
- 14.Al-Rubeaan K, Youssef AM, Subhani SN, Ahmad NA, Al-Sharqawi AH, Al-Mutlaq HM, et al. Diabetic nephropathy and its risk factors in a society with a type 2 diabetes epidemic: A Saudi national diabetes registry-based study. PLoS One. 2014;9:e88956. doi: 10.1371/journal.pone.0088956. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Alwakeel JS, Isnani AC, Alsuwaida A, Alharbi A, Shaffi SA, Almohaya S, et al. Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia. Ann Saudi Med. 2011;31:236–42. doi: 10.4103/0256-4947.81528. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Kalda R, Rätsep A, Lember M. Predictors of quality of life of patients with type 2 diabetes. Patient Prefer Adherence. 2008;2:21–6. [PMC free article] [PubMed] [Google Scholar]
- 17.Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2022;102((5S)):S1–S127. doi: 10.1016/j.kint.2022.06.008. [DOI] [PubMed] [Google Scholar]
- 18.Saudi Diabetes Clinical Practice Guidelines (SDCPG), Saudi National Diabetes Center (SNDC), Saudi Health Council. (2021) [Google Scholar]
- 19.Chengdian L, Ying Y, Hua Y. Constructing a knowledge, belief and action evaluation scale for diabetic microangiopathy in primary general practitioners using Delphi method. Chinese J General Pract. 2023;22:928–33. [Google Scholar]
- 20.Huang C, Lan C, Chen Z, Ying Y, Gao J, Yang H. Knowledge, attitude and practice regarding screening and managing diabetic microvascular complications among general practitioners of community health centres: A cross-sectional study in Shanghai, China. BMJ Open. 2025;15:e085784. doi: 10.1136/bmjopen-2024-085784. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Hua Y, Huiling X, Limin R, Qiu W, Cao X, Li S, et al. Knowledge and management capability on diabetic kidney disease among general practitioners in community health centers of Shanghai. Chin J Gen Pract. 2017;12:917–20. [Google Scholar]
- 22.Jacques V, Mauriac A, Leopold A, Sabi A, Ubald A, Vénérand A, et al. Knowledge attitude and practice of general physicians for early detection of diabetic nephropathy in Cotonou. Open J Nephrol. 2016;6:122–31. [Google Scholar]
- 23.Shera AS, Jawad F, Basit A. Diabetes related knowledge, attitude and practices of family physicians in Pakistan. J Pak Med Assoc. 2002;52:465–70. [PubMed] [Google Scholar]
- 24.Duan DF, Wen Y, Yan Y, Li L, Xiao X, Li X, et al. Chinese healthcare workers’ knowledge, attitudes, and practices in diabetic kidney management: A multi-centered cross-sectional study. Risk Manag Healthc Policy. 2024;17:1211–25. doi: 10.2147/RMHP.S354549. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
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Data Availability Statement
We encourage all authors of articles published in MDPI journals to share their research data. In this section, please provide details regarding where data supporting reported results can be found, including links to publicly archived datasets analyzed or generated during the study. Where no new data were created, or where data is unavailable due to privacy or ethical restrictions, a statement is still required. Suggested Data Availability Statements are available in section “MDPI Research Data Policies” at https://www.mdpi.com/ethics.